epilepsi - nice
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The epilepsies: the diagnosis andmanagement of the epilepsies inadults and children in primary andsecondary care
KKM: FMJQ 2012 DKL EG: EJ 2013
ICE ? 137
MF.F.GJ.M/137
*C! @K JL L@ HJGKK MK Q L@ CFLJ GJ CDFD JL L *C! LG HJGM
MDFK. AJLLGF K ND GJ 5 QJK JGE HLEJ 2009 F HHDK LG MDFK HJGM
KF AHJD 2007 MKF L@ HJGKKK KJ F *C!'K '@ MDFK EFMD' (2007, MHL
2009). GJ FGJELGF GF JLLGF F NO L OOO.F.GJ.M/JLLGF
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C>>=
FLJGMLGF................................................................................................................................. 7
JKGF-FLJ J................................................................................................................... 9
Q HJGJLK GJ EHDEFLLGF ................................................................................................ 10
FGKK............................................................................................................................................... 10
FEFL ......................................................................................................................................... 10
JGDGF GJ JHL KRMJK F GFNMDKN KLLMK HDHLMK....................................................... 10
HD GFKJLGFK GJ OGEF F JDK G @DJF HGLFLD................................................... 11
NO F JJJD ............................................................................................................................... 11
1 #MF ................................................................................................................................. 12
1.1 JFHD G KGF EF............................................................................................................ 12
1.2 CGHF OL@ HDHKQ ....................................................................................................................... 12
1.3 FGJELGF ...................................................................................................................................... 13
1.4 GDDGOF JKL KRMJ................................................................................................................... 16
1.5 FGKK......................................................................................................................................... 17
1.6 FNKLLGFK .................................................................................................................................. 18
1.7 CDKKLGF ................................................................................................................................... 22
1.8 FEFL ................................................................................................................................... 22
1.9 @JEGDGD LJLEFL ............................................................................................................. 23
1.10 JJD GJ GEHDP GJ JJLGJQ HDHKQ ................................................................................... 39
1.11 KQ@GDGD FLJNFLGFK ........................................................................................................... 41
1.12 LGF L ............................................................................................................................... 41
1.13 MK FJN KLEMDLGF (*) .................................................................................................... 42
1.14 JGDGF GJ JHL KRMJK F GFNMDKN KLLMK HDHLMK .............................................. 42
1.15 GEF F JDK OL@ HDHKQ...................................................................................................... 45
1.16 C@DJF, QGMF HGHD F MDLK OL@ DJFF KDLK (K DKG KLGFK 1.15 F 1.17)... 50
1.17 GMF HGHD OL@ HDHKQ (K DKG KLGF 1.15)...................................................................... 52
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.18 DJ HGHD OL@ HDHKQ ............................................................................................................ 53
1.19 C@DJF, QGMF HGHD F MDLK JGE D F EFGJLQ L@F JGMHK................................... 54
1.20 NO........................................................................................................................................... 54
2 *GLK GF L@ KGH G L@ MF........................................................................................ 58
3 EHDEFLLGF ....................................................................................................................... 59
4 KJ@ JGEEFLGFK ................................................................................................... 60
4.1 *ODQ FGK KRMJK (GD F FJDK) U EGFGL@JHQ................................................ 60
4.2 !HDHKQ KQFJGEK ........................................................................................................................ 61
4.3 FFLD KHKEK .............................................................................................................................. 61
4.4 JLEFL G GFNMDKN KLLMK HDHLMK (L@L K, FGL MKL JJLGJQ)........................................... 62
4.5 A!K F HJFFQ ...................................................................................................................... 63
5 L@J NJKGFK G L@K MDF ............................................................................................... 65
5.1 MDD MDF ................................................................................................................................... 65
5.2 *C! HL@OQ ................................................................................................................................. 65
5.3 FGJELGF GJ L@ HMD................................................................................................................. 65
6 DL *C! MF........................................................................................................... 66
7 HLF L@ MDF............................................................................................................. 67
AHHFP A: @ #MDF NDGHEFL #JGMH, *LGFD CDFD #MDF CFLJ F *C!
HJGL LE................................................................................................................................ 68
#MDF NDGHEFL #JGMH (2012, HJLD MHL)........................................................................... 68
#MDF NDGHEFL #JGMH (2004) .................................................................................................. 69
#MDF NDGHEFL #JGMH G-GHL PHJLK ................................................................................. 70
*LGFD CDFD #MDF CFLJ ....................................................................................................... 72
!PLJFD HJ JNOJK......................................................................................................................... 73
*C! HJGL LE................................................................................................................................. 73
AHHFP B: @ #MDF NO FD.................................................................................. 74
2012 #MDF (HJLD MHL)............................................................................................................. 74
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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2004 #MDF ...................................................................................................................................... 74
AHHFP C: MLDF J DGJL@EK ......................................................................................... 75
AHHFP : JFLD FGKK G HDHKQ F @DJF, QGMF HGHD F MDLK................. 76
AHHFP !: @JEGDGD LJLEFL .................................................................................... 77
AHHFP : JGLGGDK GJ LJLF GFNMDKN KLLMK HDHLMK F MDLK F @DJF (MDLK
HMDK@ F 2004 F @DJF HMDK@ F 2011)..................................................................... 96
JLF GFNMDKN KLLMK HDHLMK F MDLK (HMDK@ F 2004)..................................................... 96
#MDFK GJ LJLF GFNMDKN KLLMK HDHLMK F @DJF (HMDK@ F 2011)............................ 99
*GF-GFNMDKN KLLMK HDHLMK F MDLK F @DJF (2004 MDF) ........................................... 100
AHHFP #: AJNLGFK F DGKKJQ ................................................................................... 102
AKF KRMJ ................................................................................................................................... 102
A@JF ............................................................................................................................................ 103
AMFLN LJLEFL ............................................................................................................................ 103
ALGDGQ ............................................................................................................................................... 103
AFL-HDHL JM (A!) ...................................................................................................................... 103
ALGF KRMJ ....................................................................................................................................... 103
ALL ................................................................................................................................................... 103
BKDF ................................................................................................................................................ 103
BFF HDHKQ OL@ FLJGLEHGJD KHK (B!C) ......................................................................... 104
CJJ .................................................................................................................................................... 104
C@D@GG KF HDHKQ ................................................................................................................ 104
CDFD HJKFLLGF ............................................................................................................................. 104
CDFF ................................................................................................................................................ 104
CGEGJLQ .......................................................................................................................................... 104
CGFGJF ........................................................................................................................................ 105
CGFLFMGMK KH F ON MJF KDGO KDH (C) ...................................................................... 105
CGFNMDKN KLLMK HDHLMK ............................................................................................................... 105
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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GK ................................................................................................................................................. 105
JNL KQFJGE .................................................................................................................................. 105
!DLJGJGJE (!C#) ..................................................................................................................... 105
!DLJGFH@DGJE (!!#) .............................................................................................................. 106
!HDHKQ ................................................................................................................................................ 106
!HDHKQ KQFJGE ............................................................................................................................... 106
!HDHL KRMJ ................................................................................................................................... 106
GD KRMJ ........................................................................................................................................ 106
#FJDK KRMJ ............................................................................................................................. 106
#FJDK LGFUDGF (#C) KRMJ .............................................................................................. 107
#FL (OL@ JJF LG HDHKQ) ..................................................................................................... 107
LD H@FGEFGDGQ ............................................................................................................................ 107
GHL@ .............................................................................................................................................. 107
GHL@ FJDK HDHKQ (#!) .................................................................................................. 107
FLGF (KH) ............................................................................................................................... 107
FFLD KHKEK ................................................................................................................................... 108
FLJNFLGF ........................................................................................................................................... 108
MNFD KF HDHKQ ................................................................................................................... 108
MNFD EQGDGF HDHKQ (!) ...................................................................................................... 108
LGF L ...................................................................................................................................... 108
FMUDFJ KQFJGE () ........................................................................................................ 108
L-GFKL @D@GG GHLD HDHKQ (#KLML LQH) ........................................................................ 109
FFGPU#KLML KQFJGE .................................................................................................................. 109
GFGL@JHQ ........................................................................................................................................ 109
QGDGF-KLL HDHKQ (A!) ........................................................................................................ 109
QGDGF KRMJK ............................................................................................................................... 109
*MJGDGD L ............................................................................................................................... 109
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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*GF-GFNMDKN KLLMK HDHLMK ........................................................................................................ 110
*GF-HDHL LL KGJJ (*!A) .................................................................................................. 110
DJ HGHD ......................................................................................................................................... 110
FQGLGHGMDGK KQFJGE .................................................................................................................. 110
@JEGFLK ................................................................................................................................. 110
GDQH@JEQ ....................................................................................................................................... 110
GDQL@JHQ .......................................................................................................................................... 111
JGFGKK ............................................................................................................................................. 111
JGNGLGF L@FIMK ........................................................................................................................ 111
MDLQ G D ......................................................................................................................................... 111
JLGJQ KLLMK HDHLMK ................................................................................................................ 111
GFJDQ FJDK KRMJ .......................................................................................................... 111
EHD F GEHDP HJLD HDHL KRMJK ..................................................................................... 112
HDKL (K MK F L@K MDF) .................................................................................................... 112
MF MFPHL (GJ MFPHDF) L@ F HDHKQ (!) ...................................................... 112
QFGH ............................................................................................................................................... 112
JLJQ HDHKQ KHDKL .................................................................................................................... 112
JLJQ KJN ..................................................................................................................................... 112
GF KRMJ ........................................................................................................................................ 113
GFUDGF KRMJ ............................................................................................................................. 113
C@FK LJ HMDLGF........................................................................................................... 114
AGML L@K MDF .................................................................................................................... 115
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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@K MF MHLK F JHDK *C! DFD MDF 20. @K MF DKG MHLKF JHDK *C! L@FGDGQ HHJKD 76 (2004) F *C! L@FGDGQ HHJKD 79
(2004).
*O JGEEFLGFK @N F GJ L@ H@JEGDGD LJLEFL G HGHD OL@
HDHKQ, FDMF L@ MK GLGF L (KAGML L@K MDF GJ LDK).
!HDHKQ K GEEGF FMJGDGD KGJJ @JLJK Q JMJJF KRMJK. JFL LQHK
G HDHKQ @N JFL MKK. AMJL KLELK G FF F HJNDF J MDL LG
@N MK FLQF HGHD O@G EQ @N HDHKQ K MDL. !HDHKQ @K FKLEL LG L LOF 362,000 F 415,000 HGHD F !FDF. F LGF, L@J ODD
MJL@J FNMDK, KLEL LG 5U30%, KG EGMFLF LG MH LG FGL@J 124,500 HGHD, O@G
@N F FGK OL@ HDHKQ, ML F O@GE L@ FGKK K FGJJL. FF K
KLEL LG 50 HJ 100,000 HJ QJ F L@ HJNDF G LN HDHKQ F L@ K
KLEL LG 5U10 KK HJ 1000. OG-L@JK G HGHD OL@ LN HDHKQ @N L@J
HDHKQ GFLJGDD KLKLGJDQ OL@ FL-HDHL JMK (A!K). L@J HHJG@K EQ FDM
KMJJQ. HLED EFEFL EHJGNK @DL@ GMLGEK F F DKG @DH LG EFEK GL@J,
GLF LJEFLD, EHLK GF KGD, MLGFD F EHDGQEFL LNLQ. @ HDHKK (*C!
DFD MDF 20) KLL L@L L@ FFMD KLEL GKL G KLDK@ HDHKK OK
S2 DDGF (JL F FJL GKLK).
*OJ F EGJ PHFKN A!K J FGO F HJKJ, F OL@ F FJK F LJLEFL
GKLK DDQ F GEF QJK L K KKFLD LG FKMJ L@L A!K OL@ HJGNF DFD F GKL
LNFKK J FL. @ NF MK LG NDGH @ HDHKK (*C! DFD
MDF 20), *OJ JMK GJ HDHKQ F MDLK (*C! L@FGDGQ HHJKD MF 76) F
*OJ JMK GJ HDHKQ F @DJF (*C! L@FGDGQ HHJKD MF 79) K@GO FG
JF F LNFKK LOF FOJ F GDJ A!K, GJ LOF L@ FOJ JMK (K
EGFGL@JHQ) GJ KRMJ GFLJGD. $GONJ, JFL DJ EMDLFLJ LJD (L@ A*A LJD)
NDMLF FOJ JMK F FODQ FGK HDHKQ (HLF KGE DELLGFK) KMKL L@L
KGME NDHJGL K@GMD L@ JM G @G F FJDK F MFDKKD HDHKK, F
DEGLJF F GD HDHKK. L OK L@JGJ GFKJ FKKJQ LG JNO FO NF
JJF A!K OL@F F MHL G *C! DFD MDF 20 (O@@ OK HMDK@ F 2004).
@ MDF ODD KKME L@L HJKJJK ODD MK JM'K KMEEJQ G HJGML @JLJKLK LG
FGJE KGFK E OL@ FNMD HLFLK.
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#epilepsyhttp://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#ketogenic-diet-2http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-and-cg137/about-this-guidelinehttp://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#anti-epileptic%20drugs%20(AEDs)http://www.nice.org.uk/guidance/CG20http://www.nice.org.uk/guidance/CG20http://www.nice.org.uk/guidance/TA76http://www.nice.org.uk/guidance/TA79http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#monotherapyhttp://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#monotherapyhttp://www.nice.org.uk/guidance/TA79http://www.nice.org.uk/guidance/TA76http://www.nice.org.uk/guidance/CG20http://www.nice.org.uk/guidance/CG20http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#anti-epileptic%20drugs%20(AEDs)http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-and-cg137/about-this-guidelinehttp://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#ketogenic-diet-2http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-cg137/appendix-g-abbreviations-and-glossary#epilepsy -
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@K MDF JGEEFK KGE JMK GJ FLGFK GJ O@@ L@Q G FGL @N
EJLF ML@GJKLGF L L@ L G HMDLGF, L@J K GG NF LG KMHHGJL L@L MK.
@J JGEEFLGFK @N F E GJ L@ MK G JMK GMLK L@J DFK FLGFK
('G-DD MK'), L@K JMK J EJ OL@ GGLFGL F L@ JGEEFLGFK.
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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K ;>
@ GDDGOF JGEEFLGFK @N F FL K HJGJLK GJ EHDEFLLGF.
Diagnosis
ADD @DJF, QGMF HGHD F MDLK OL@ JFL GFKL KMKHL KRMJ K@GMD KF
MJFLDQ1 Q KHDKL2. @K K LG FKMJ HJK F JDQ FGKK F FLLGF G
L@JHQ K HHJGHJL LG L@J FK. *2004+
Management
$DL@J HJGKKGFDK K@GMD GHL GFKMDLF KLQD L@L FDK L@ @D, QGMF
HJKGF GJ MDL OL@ HDHKQ, F L@J EDQ F/GJ JJK K HHJGHJL, LG HJLHL K
HJLFJK F DD KGFK GML L@J @DL@J, F L MDDQ FLG GMFL L@J J, MDLMJ
F FQ KH FK. *2004+
ADD @DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD @N GEHJ@FKN J HDF
L@L K J LOF L@ HJKGF, L@J EDQ F/GJ JJK K HHJGHJL, F HJEJQ
F KGFJQ J HJGNJK. *2004+
@ A! (FL-HDHL JM) LJLEFL KLJLQ K@GMD FNMDK GJF LG L@
KRMJ LQH, HDHKQ KQFJGE, G-ELGF F G-EGJLQ, L@ @D, QGMF HJKGF GJ
MDL'K DKLQD, F L@ HJJFK G L@ HJKGF, L@J EDQ F/GJ JJK K HHJGHJL.
*2004+
Prolonged or repeated seizures andconvulsive status
epilepticus
FDQ HJKJ MD ERGDE GJ JLD RHE3 GJ MK F L@ GEEMFLQ GJ @DJF,
QGMF HGHD F MDLK O@G @N @ HJNGMK HKG G HJGDGF GJ KJD GFNMDKN
KRMJK. * 2012+
AEFKLJ MD ERGDE K JKL-DF LJLEFL F @DJF, QGMF HGHD F MDLK OL@
HJGDGF GJ JHL KRMJK F L@ GEEMFLQ. AEFKLJ JLD RHE3 HJJJ
GJ MD ERGDE K FGL NDD. FLJNFGMK KK K DJQ KLDK@ F
JKMKLLGF DLK J NDD, EFKLJ FLJNFGMK DGJRHE. * 2012+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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Special considerations for women and girls of childbearing
potential
GEF F JDK OL@ HDHKQ F L@J HJLFJK, K HHJGHJL, EMKL NF MJL
FGJELGF F GMFKDDF GML GFLJHLGF, GFHLGF, HJFFQ, JF GJ @DJF,
JKLF F EFGHMK. *2004+
Review and referral
ADD @DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD @N JMDJ KLJMLMJ JNO.
F @DJF F QGMF HGHD, L@K JNO K@GMD JJ GML L DKL QJDQ (ML EQ
LOF 3 F 12 EGFL@K Q JJFEFL) Q KHDKL. F MDLK, L@K JNO K@GMD
JJ GML L DKL QJDQ Q L@J FJDKL GJ KHDKL, HFF GF @GO ODD L@
HDHKQ K GFLJGDD F/GJ L@ HJKF G KH DKLQD KKMK. *2004+
AL L@ JNO, @DJF, QGMF HGHD F MDLK K@GMD @N KK LG: OJLLF F NKMD
FGJELGF; GMFKDDF KJNK; FGJELGF GML NGDMFLJQ GJFKLGFK; HDHKQ
KHDKL FMJKK; LEDQ F HHJGHJL FNKLLGFK; JJJD LG LJLJQ KJNK, FDMF
KMJJQ HHJGHJL. *2004+
KRMJK J FGL GFLJGDD F/GJ L@J K FGKL MFJLFLQ GJ LJLEFL DMJ,
@DJF, QGMF HGHD F MDLK K@GMD JJJ LG LJLJQ KJNK KGGF4 GJ MJL@J
KKKKEFL. *2004+
1 @ #MDF NDGHEFL #JGMH GFKJ L@L 'MJFLDQ' EFL F KF OL@F 2 OK.
2 GJ MDLK, KHDKL K F L@JGM@GML K ED HJLLGFJ OL@ LJFF F
PHJLK F HDHKQ. GJ @DJF F QGMF HGHD, KHDKL K F L@JGM@GML K
HLJF OL@ LJFF F PHJLK F HDHKQ.
3AL L@ LE G HMDLGF (FMJQ 2012), L@K JM FGL @N EJLF ML@GJKLGF GJ
L@K FLGF F/GJ HGHMDLGF (K HHFP ! GJ LDK). FGJE GFKFL K@GMD
GLF F GMEFL F DF OL@ FGJED KLFJK F EJFQ J.
4 @ #MDF NDGHEFL #JGMH GFKJ L@L 'KGGF' EFL F KF OL@F 4 OK.
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
T *C! 2012. ADD J@LK JKJN. KL EG EJ 2013 11 G 116
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1 G?
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L@K JF K K GF NF JNO Q L@ #MDF NDGHEFL #JGMH. $GONJ, L
K JGFK L@L L@J K NJD JF (15U19 QJK) L O@@ J K LJFKJJ
LOF @D F MDL @DL@ KJNK Q DGD @DL@J LJMKLK F HJEJQ J
GJFKLGFK.
DK K HHFP # GJ FLGFK G JNLGFK F DGKKJQ G LJEK MK L@JGM@GML
L@K MDF.
1.1 Principle of decision making
1.1.1 $DL@J HJGKKGFDK K@GMD GHL GFKMDLF KLQD L@L FDK L@ @D,
QGMF HJKGF GJ MDL OL@ HDHKQ, F L@J EDQ F/GJ JJK K
HHJGHJL, LG HJLHL K HJLFJK F DD KGFK GML L@J @DL@J,
F L MDDQ FLG GMFL L@J J, MDLMJ F FQ KH FK. *2004+
1.2 Coping with epilepsy
1.2.1 C@DJF, QGMF HGHD F MDLK OL@ HDHKQ F L@J EDK F/GJ
JJK K@GMD EHGOJ LG EF L@J GFLGF K ODD K HGKKD.
*2004+
1.2.2 AMDLK K@GMD JN HHJGHJL FGJELGF F MLGF GML DD KHLK
G HDHKQ. @K EQ KL @N F EFLF L@JGM@ KLJMLMJ KD-
EFEFL HDFK. *2004+
1.2.3 F @DJF F QGMF HGHD, KD-EFEFL G HDHKQ EQ KL
@N L@JGM@ LN @D-FLJ LJFF EGDK F FLJNFLGFK. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
T *C! 2012. ADD J@LK JKJN. KL EG EJ 2013 12 G 116
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1.2.4 $DL@J HJGKKGFDK K@GMD @@D@L L@ !PHJL LFLK JGJEE
(OOO.PHJLHLFLK.G.M5) LG @DJF, QGMF HGHD F MDLK OL@ HDHKQ
O@G OK@ LG EF L@J GFLGF EGJ LNDQ. *2004, 2012+
1.3 Information
1.3.1 C@DJF, QGMF HGHD F MDLK OL@ HDHKQ F L@J EDK F/GJ
JJK K@GMD NF, F @N KK LG KGMJK G, FGJELGF GML
(O@J HHJGHJL):
HDHKQ F FJD
FGKK F LJLEFL GHLGFK
ELGF F K LK
KRMJ LQH(K), LJJK F KRMJ GFLJGD
EFEFL F KD-J
JK EFEFL
JKL , KLQ F FMJQ HJNFLGF L @GE F L K@GGD GJ OGJ
HKQ@GDGD KKMK
KGD KMJLQ FLK F KGD KJNK
FKMJF KKMK
MLGF F @DL@J L K@GGD
EHDGQEFL F FHFFL DNF GJ MDLK
EHGJLF G KDGKF HDHKQ L OGJ, JDNFL ( MJL@J FGJELGF GJ
DJLGF K F, NGDMFLJQ GJFKLGFK K@GMD GFLL)
JG KLQ F JNF
HJGFGKK
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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KMF L@ F HDHKQ (!)
KLLMK HDHLMK
DKLQD, DKMJ F KGD KKMK (FDMF JJLGFD JMK, DG@GD, KPMD
LNLQ F KDH HJNLGF)
EDQ HDFFF F HJFFQ
NGDMFLJQ GJFKLGFK, KM@ K KMHHGJL JGMHK F @JLD GJFKLGFK, F
@GO LG GFLL L@E. *2004+
1.3.2 @ LE L O@@ L@K FGJELGF K@GMD NF ODD HF GF L@ JLFLQ
G L@ FGKK, F L@ F GJ GFJELGJQ FNKLLGFK. *2004+
1.3.3 FGJELGF K@GMD HJGN F GJELK, DFMK F OQK L@L J KML
LG L@ @D, QGMF HJKGF GJ MDL'K JIMJEFLK. CGFKJLGF K@GMD
NF LG NDGHEFLD , FJ, MDLMJ F KL G D G L@ HJKGF.
*2004+
1.3.4 @DJF, QGMF HGHD F MDLK, F L@J EDK F/GJ JJK, @N FGL
DJQ GMF @@-IMDLQ FGJELGF JGE NGDMFLJQ GJFKLGFK F GL@JKGMJK, @DL@J HJGKKGFDK K@GMD FGJE L@E G JFL KGMJK
(MKF L@ FLJFL, HHJGHJL: K, GJ PEHD, L@ OKL G L@ GFL
!HDHKQ CGMFD G L@ F JDF, OOO.GFLHDHKQGMFD.GJ.M).
*2004+
1.3.5 AIML LE K@GMD KL K F L@ GFKMDLLGF LG HJGN FGJELGF,
O@@ K@GMD JNKL GF KMKIMFL GFKMDLLGFK. *2004+
1.3.6 C@DKLK K@GMD MK LG JEF @DJF, QGMF HGHD F MDLK, F
@DL@J HJGKKGFDK, GML FGJELGF L@L K@GMD KMKK MJF
GFKMDLLGFK. *2004+
1.3.7 !NJQGF HJGNF J GJ LJLEFL GJ @DJF, QGMF HGHD F MDLK
OL@ HDHKQ K@GMD D LG HJGN KKFLD FGJELGF. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
T *C! 2012. ADD J@LK JKJN. KL EG EJ 2013 14 G 116
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1.3.8 @ @D, QGMF HJKGF GJ MDL OL@ HDHKQ F L@J EDQ F/GJ JJK K
HHJGHJL K@GMD FGO @GO LG GFLL FE FNMD O@F FGJELGF
K F. @K FE FNMD K@GMD EEJ G L@ @DL@J LE
F JKHGFKD GJ FKMJF L@L L@ FGJELGF FK G L@ @D, QGMF
HJKGF GJ MDL F/GJ L@J EDQ F/GJ JJK J EL. *2004+
1.3.9 @ HGKKDLQ G @NF KRMJK K@GMD KMKK, F FGJELGF GF
HDHKQ K@GMD HJGN GJ KRMJK GMJ, GJ @DJF, QGMF HGHD
F MDLK L @@ JK G NDGHF KRMJK (KM@ K LJ KNJ JF
FMJQ), OL@ DJFF KDLQ, GJ O@G @N KLJGF EDQ @KLGJQ G
HDHKQ. *2004+
1.3.10 C@DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD NF HHJGHJL
FGJELGF GJ L@Q E EHGJLFL KGFK (GJ PEHD, JJF
HJFFQ GJ EHDGQEFL). *2004+
$? ?;> > ;;= ($&DE")
1.3.11 FGJELGF GF ! K@GMD FDM F DLJLMJ GF HDHKQ LG K@GO
O@Q HJNFLF KRMJK K EHGJLFL. DGJ FGJELGF GF L@ HJKGF'K
JDLN JK G ! K@GMD HJL G L@ GMFKDDF @DKL GJ @DJF,
QGMF HGHD F MDLK OL@ HDHKQ F L@J EDK F/GJ JJK. *2004+
1.3.12 @ JK G ! F EFEK Q:
GHLEKF KRMJ GFLJGD
F OJ G L@ HGLFLD GFKIMFK G FGLMJFD KRMJK. *2004+
1.3.13 DGJ FGJELGF F KMKKGF LOF L@ @D, QGMF HJKGF GJ MDL
OL@ HDHKQ, L@J EDQ F/GJ JJK (K HHJGHJL) F @DL@J
HJGKKGFDK K@GMD L GMFL G L@ KEDD ML FL JK G !.
*2004+
1.3.14 @J EDK F/GJ JJK @N F L Q !, @DL@J
HJGKKGFDK K@GMD GFLL EDK F/GJ JJK LG GJ L@J GFGDFK,
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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FNL L@E LG KMKK L@ L@, F GJ JJJD LG JNEFL GMFKDDF
F ! KMHHGJL JGMH. *2004+
1.4 Following a first seizure
1.4.1 C@DJF, QGMF HGHD F MDLK HJKFLF LG F AFL F !EJFQ
HJLEFL GDDGOF KMKHL KRMJ K@GMD KJF FLDDQ. @K
K@GMD GF Q F MDL GJ HLJ H@QKF OL@ GFOJ JJJD LG
KHDKL6 O@F F HDHL KRMJ K KMKHL GJ L@J K FGKL GML.
*2004+
1.4.2 JGLGGDK K@GMD F HD L@L FKMJ HJGHJ KKKKEFL F L@ EJFQ
KLLF GJ @DJF, QGMF HGHD F MDLK HJKFLF OL@ F HDHL
KRMJ (KMKHL GJ GFJE). *2004+
1.4.3 @ FGJELGF L@L K@GMD GLF JGE L@ MDL F/GJ EDQ GJ JJ
LJ KMKHL KRMJ K GFLF F HHFP . *2004+
1.4.4 @ FGJELGF L@L K@GMD GLF JGE L@ @D GJ QGMF HJKGF F/GJ
HJFL GJ JJ LJ KMKHL KRMJ K GFLF F HHFP . *2004+
1.4.5 L K JGEEF L@L DD MDLK @NF JKL KRMJ K@GMD KF K KGGF
K HGKKD7 Q KHDKL F L@ EFEFL G L@ HDHKK LG FKMJ
HJK F JDQ FGKK F FLLGF G L@JHQ K HHJGHJL LG L@J
FK. *2004+
1.4.6 L K JGEEF L@L DD @DJF F QGMF HGHD O@G @N @ JKL FGF-
JD KRMJ K@GMD KF K KGGF K HGKKD
7
Q KHDKL F L@EFEFL G L@ HDHKK LG FKMJ HJK F JDQ FGKK F
FLLGF G L@JHQ K HHJGHJL LG L@J FK. *2004+
1.4.7 AL L@ FLD KKKKEFL GJ JFL GFKL KRMJ, L@ KHDKL K@GMD @N
KK LG HHJGHJL FNKLLGFK. *2004+
1.4.8 F @D, QGMF HJKGF GJ MDL HJKFLF OL@ F LL, H@QKD
PEFLGF K@GMD JJ GML. @K K@GMD JKK L@J J,
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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FMJGDGD F EFLD KLLMK, F K@GMD FDM NDGHEFLD
KKKKEFL O@J HHJGHJL. *2004+
1.4.9 !KKFLD FGJELGF GF @GO LG JGFK KRMJ, JKL , F L@
EHGJLF G JHGJLF MJL@J LLK K@GMD HJGN LG @D, QGMF
HJKGF GJ MDL O@G @K PHJF HGKKD JKL KRMJ, F L@J EDQ/
JJ/HJFL K HHJGHJL. @K FGJELGF K@GMD HJGN O@D L@
@D, QGMF HJKGF GJ MDL K OLF FGKK F K@GMD DKG
HJGN LG L@J EDQ F/GJ JJK. *2004+
1.5 Diagnosis
1.5.1 @ FGKK G HDHKQ F MDLK K@GMD KLDK@ Q KHDKL
ED HJLLGFJ OL@ LJFF F PHJLK F HDHKQ. *2004+
1.5.2 @ FGKK G HDHKQ F @DJF F QGMF HGHD K@GMD KLDK@
Q KHDKL HLJF OL@ LJFF F PHJLK F HDHKQ. *2004+
1.5.3 C@DJF, QGMF HGHD F MDLK F L@J EDK F/GJ JJK K@GMD
NF F GHHGJLMFLQ LG KMKK L@ FGKK OL@ F HHJGHJL @DL@JHJGKKGFD. *2004+
1.5.4 A LD @KLGJQ K@GMD LF JGE L@ @D, QGMF HJKGF GJ MDL F F
QOLFKK LG L@ LL, O@J HGKKD, LG LJEF O@L@J GJ FGL F
HDHL KRMJ K DDQ LG @N GMJJ. *2004+
1.5.5 @ DFD KGF K LG O@L@J F HDHL KRMJ @K GMJJ K@GMD
L@F K GF L@ GEFLGF G L@ KJHLGF G L@ LL F JFLKQEHLGEK. FGKK K@GMD FGL K GF L@ HJKF GJ KF G
KFD LMJK. *2004+
1.5.6 L EQ FGL HGKKD LG E FL FGKK G HDHKQ. L@ FGKK
FFGL DJDQ KLDK@, MJL@J FNKLLGFK (K KLGF 1.6) F/GJ
JJJD LG LJLJQ HDHKQ KHDKL8 (K JGEEFLGF 1.10.2) K@GMD
GFKJ. GDDGO-MH K@GMD DOQK JJF. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.5.7 @J FGF-HDHL LL KGJJK KMKHL, KMLD JJJD K@GMD
E LG HKQ@GDGD GJ HKQ@LJ KJNK GJ MJL@J FNKLLGF F
LJLEFL. *2004+
1.5.8 JGKHLN JGJF G NFLK, FDMF NG JGJF F OJLLF
KJHLGFK, F NJQ @DHMD F J@F FGKK. *2004+
1.6 Investigations
1.6.1 FGJELGF K@GMD HJGN LG @DJF, QGMF HGHD F MDLK F
EDK F/GJ JJK K HHJGHJL GF L@ JKGFK GJ LKLK, L@J JKMDLK F
EFF, L@ JIMJEFLK G KH FNKLLGFK, F L@ DGKLK G
GLFF L@E. *2004+
1.6.2 ADD FNKLLGFK GJ @DJF K@GMD HJGJE F @D-FLJ
FNJGFEFL. *2004+
E>
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1.6.7 @ !!# K@GMD FGL MK LG PDM FGKK G HDHKQ F @D,
QGMF HJKGF GJ MDL F O@GE L@ DFD HJKFLLGF KMHHGJLK FGKK G
FGF-HDHL NFL. *2004+
1.6.8 @ !!# K@GMD FGL MK F KGDLGF LG E FGKK G HDHKQ.
*2004+
1.6.9 AF !!# EQ MK LG @DH LJEF KRMJ LQH F HDHKQ KQFJGE F
@DJF, QGMF HGHD F MDLK F O@GE HDHKQ K KMKHL. @K FDK
L@E LG NF L@ GJJL HJGFGKK. *2004+
1.6.10 F @DJF, QGMF HGHD F MDLK HJKFLF OL@ JKL MFHJGNGKRMJ, MFIMNGD HDHLGJE LNLQ K@GOF GF !!# F MK LG
KKKK L@ JK G KRMJ JMJJF. *2004+
1.6.11 GJ @DJF, QGMF HGHD F MDLK F O@GE HDHKQ K KMKHL, ML O@G
HJKFL FGKL MDLK, KHDKL FNKLLGFK K@GMD
NDD. *2004+
1.6.12 HL KLFJ !!#K EQ @DHMD O@F L@ FGKK G L@ HDHKQ GJL@ KQFJGE K MFDJ. $GONJ, L@ FGKK @K F KLDK@,
JHL !!#K J FGL DDQ LG @DHMD. *2004+
1.6.13 HL KLFJ !!#K K@GMD FGL MK F HJJF LG KDH GJ KDH-
HJN !!#K. *2004+
1.6.14 @F KLFJ !!# @K FGL GFLJML LG FGKK GJ DKKLGF,
KDH !!# K@GMD HJGJE. *2004+
1.6.15 F @DJF F QGMF HGHD, KDH !!# K KL @N L@JGM@ KDH
HJNLGF GJ L@ MK G EDLGFF10. *2004, 2012+
1.6.16 GF-LJE NG GJ EMDLGJQ !!# EQ MK F L@ KKKKEFL G
@DJF, QGMF HGHD F MDLK O@G HJKFL FGKL MDLK LJ
DFD KKKKEFL F KLFJ !!#. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.6.17 JGNGLGF Q KMKLGF EQ MK F L@ NDMLGF G FGF-HDHL
LL KGJJ. $GONJ, L @K DEL JGD F EQ D LG DK-HGKLN
JKMDLK F KGE HGHD. *2004+
1.6.18 @GL KLEMDLGF F @QHJNFLDLGF K@GMD JEF HJL G KLFJ !!#
KKKKEFL. @ @D, QGMF HJKGF GJ MDL F EDQ F/GJ JJ K@GMD
E OJ L@L KM@ LNLGF HJGMJK EQ FM KRMJ F L@Q
@N J@L LG JMK. *2004+
?
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!>< >=>=
1.6.26 KMJEFL G KJME HJGDLF K FGL JGEEF GJ L@ FGKK G
HDHKQ. *2004+
1.6.27 F MDLK, HHJGHJL DGG LKLK (GJ PEHD, HDKE DLJGDQLK, DMGK,
DME) LG FLQ HGLFLD MKK F/GJ LG FLQ FQ KFFL G-
EGJLQ K@GMD GFKJ. *2004+
1.6.28 F @DJF F QGMF HGHD, GL@J FNKLLGFK, FDMF DGG F MJF
G@EKLJQ, K@GMD MFJLF L L@ KJLGF G L@ KHDKL LG
PDM GL@J FGKK, F LG LJEF F MFJDQF MK G L@HDHKQ. *2004+
1.6.29 A 12-D !C# K@GMD HJGJE F MDLK OL@ KMKHL HDHKQ. *2004+
1.6.30 F @DJF F QGMF HGHD, 12-D !C# K@GMD GFKJ F KK G
FGKL MFJLFLQ. *2004+
1.6.31 F KK G FGKL MFJLFLQ, JJJD LG JGDGKL K@GMD
GFKJ. *2004+
?
1.6.32 *MJGHKQ@GDGD KKKKEFL K@GMD GFKJ F @DJF, QGMF
HGHD F MDLK F O@GE L K EHGJLFL LG NDML DJFF KDLK F
GFLN QKMFLGF, HJLMDJDQ F JJ LG DFM F EEGJQ. *2004+
1.6.33 JJD GJ FMJGHKQ@GDGD KKKKEFL K FL:
O@F @D, QGMF HJKGF GJ MDL OL@ HDHKQ K @NF MLGFD GJ
GMHLGFD MDLK
O@F F @K FL FGJEDLK F GFLNDQ EHGJLFL JF JGFK
O@F @D, QGMF HJKGF GJ MDL GEHDFK G EEGJQ GJ GL@J GFLN LK
F/GJ GFLN DF. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.7 Classification
1.7.1 !HDHL KRMJK F HDHKQ KQFJGEK F @DJF, QGMF HGHD F
MDLK K@GMD DKK MKF EMDL-PD FGKL K@E. @ PK
L@L K@GMD GFKJ J: KJHLGF G KRMJ (LD H@FGEFGDGQ);
KRMJ LQH; KQFJGE F LGDGQ. *2004+
1.7.2 @ KRMJ LQH(K) F HDHKQ KQFJGE, LGDGQ, F G-EGJLQ K@GMD
LJEF, MK DMJ LG DKKQ L@ HDHKQ KQFJGE GJJLDQ F
D LG FHHJGHJL LJLEFL F HJKKLF G KRMJK. *2004+
1.7.3 C@DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD NF FGJELGF
GML L@J KRMJ LQH(K) F HDHKQ KQFJGE, F L@ DDQ HJGFGKK.
*2004+
1.8 Management
1.8.1 C@DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD @N F KKD
HGFL G GFLL OL@ KHDKL KJNK. *2004+
1.8.2 ADD @DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD @N
GEHJ@FKN J HDF L@L K J LOF L@ HJKGF, EDQ F/GJ
JJK O@J HHJGHJL, F HJEJQ J F KGFJQ J HJGNJK.
@K K@GMD FDM DKLQD KKMK K ODD K ED KKMK. *2004+
1.8.3 !HDHKQ KHDKL FMJKK (!*K) K@GMD F FLJD HJL G L@ FLOGJ G
J G @DJF, QGMF HGHD F MDLK OL@ HDHKQ. @ Q JGDK G L@
!*K J LG KMHHGJL GL@ HDHKQ KHDKLK F FJDKLK, LG FKMJKK LG GEEMFLQ F EMDL-FQ KJNK F LG HJGN FGJELGF,
LJFF F KMHHGJL LG L@ @D, QGMF HJKGF GJ MDL, EDK, JJK F, F
L@ K G @DJF, GL@JK FNGDN F L@ @D'K MLGF, ODJ F ODD-
F. *2004+
1.8.4 $DL@J HJGKKGFDK @N JKHGFKDLQ LG ML GL@JK GML
HDHKQ KG K LG JM L@ KLE KKGL OL@ L. @Q K@GMD HJGN
FGJELGF GML HDHKQ LG DD HGHD O@G GE FLG GFLL OL@ @DJF,
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
T *C! 2012. ADD J@LK JKJN. KL EG EJ 2013 22 G 116
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QGMF HGHD F MDLK OL@ HDHKQ, FDMF K@GGD KL, KGD J
HJGKKGFDK F GL@JK. *2004+
1.9 Pharmacological treatment
*GL: K HHFP ! GJ MJL@J LDK G H@JEGDGD LJLEFL.
@ ## K OJ G L@ GFLJFLGFK LG HJKJF JERHF LG KGE HGHD G $F
C@FK GJ @ GJF. GEEFLGFK F L@K KLGF GJ DLJFLNK, F KG FG KH
JGEEFLGFK J E GJ L@K JGMHK.
@ ## K DKG OJ G KH KKMK OL@ HJKJF KGME NDHJGL LG JDK F OGEF
G @DJF . GEEFLGFK F L@K KLGF GJ DLJFLN HJKJF GHLGFK GJ L@K
JGMH. GEEFLGFK 1.9.1.10, 1.9.17.3, 1.9.17.6, 1.9.17.9 F 1.15.1.4 DKG HJGN
LGFD KH FGJELGF G JDNF O@F GFKJF HJKJF A!K LG OGEF G
@DJF .
*C! @K DKG KKM MF GF L@ MK G JLF K F GHLGF GJ L@ MFLN LJLEFL
GHJLD (L@ LJE GD @K F MK F L@K MDF) GFKL KRMJK OL@ GJ OL@GML
KGFJQ FJDKLGF F MDLK 18 QJK F GDJ OL@ HDHKQ F LF GJ L@MFLN LJLEFL G HJLD GFKL KRMJK F HDHKQ (*C! L@FGDGQ HHJKD MF
232).
1.9.1 G ;>
1.9.1.1 FGJELGF L@L K HJGN GML FL-HDHL JMK (A!K) FK LG F
L@ GFLPL G L@L HJGN Q L@ EFMLMJJ, GJ PEHD, FLGFK, K
LK F DF KLLMK. *2004+
1.9.1.2 @ A! LJLEFL KLJLQ K@GMD FNMDK GJF LG L@ KRMJ
LQH, HDHKQ KQFJGE, G-ELGF F G-EGJLQ, L@ @D, QGMF
HJKGF GJ MDL'K DKLQD, F L@ HJJFK G L@ HJKGF F L@J EDQ
F/GJ JJK K HHJGHJL (K HHFP !). *2004+
1.9.1.3 @ FGKK G HDHKQ FK LG JLDDQ NDML NFLK GFLFM
KHL F GHLED GK G JKL-DF A!. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
T *C! 2012. ADD J@LK JKJN. KL EG EJ 2013 23 G 116
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1.9.1.4 CGFKKLFL KMHHDQ LG L@ @D, QGMF HJKGF GJ MDL OL@ HDHKQ G
HJLMDJ EFMLMJJ'K A! HJHJLGF K JGEEF, MFDKK L@
HJKJJ, F GFKMDLLGF OL@ L@ @D, QGMF HJKGF, MDL F L@J EDQ
F/GJ JJK K HHJGHJL, GFKJK L@L L@K K FGL GFJF. JFL
HJHJLGFK G KGE A!K EQ NJQ F GNDDLQ GJ H@JEGFL
HJGDK F J FK LG LF LG NG JM L GJ PKKN K
LK. CGFKMDL L@ KMEEJQ G HJGML @JLJKLK (C) F 'BJLK@
FLGFD GJEMDJQ' (B*; NDD L @LLH://F.GJ) GF L@ GNDDLQ F
H@JEGFL HJGDK G FNMD A!K, ML FGL L@L L@K G FGL N
FGJELGF GF GEHJF GNDDLQ G JFL FJ HJHJLGFK11,12.
* 2012+
1.9.1.5 L K JGEEF L@L @DJF, QGMF HGHD F MDLK K@GMD LJL
OL@ KFD A! (EGFGL@JHQ) O@JNJ HGKKD. L@ FLD LJLEFL K
MFKMKKMD, L@F EGFGL@JHQ MKF FGL@J JM F LJ. CMLGF K
F MJF L@ @FGNJ HJG. *2004+
1.9.1.6 F A! @K D MK G NJK LK GJ GFLFM KRMJK,
KGF JM K@GMD KLJL (O@@ EQ F DLJFLN JKL-DF GJ
KGF-DF JM) F MDL MH LG F IML GJ EPEME LGDJL GK FL@F L@ JKL JM K@GMD LHJ G KDGODQ. *2004+
1.9.1.7 L@ KGF JM K MF@DHMD, L@J L@ JKL GJ KGF JM EQ LHJ,
HFF GF JDLN Q, K LK F @GO ODD L@ JMK J
LGDJL GJ KLJLF FGL@J JM. *2004+
1.9.1.8 L K JGEEF L@L GEFLGF L@JHQ (MFLN GJ '-GF' L@JHQ)
K@GMD GFDQ GFKJ O@F LLEHLK L EGFGL@JHQ OL@ A!K @N FGL
JKMDL F KRMJ JGE. LJDK G GEFLGF L@JHQ G FGL JF GML
OGJL@O@D FLK, LJLEFL K@GMD JNJL LG L@ JEF (EGFGL@JHQ GJ
GEFLGF L@JHQ) L@L @K HJGN EGKL HLD LG L@ @D, QGMF
HJKGF GJ MDL, F LJEK G HJGNF L@ KL DF LOF LNFKK
F JMF KRMJ JIMFQ F LGDJDLQ G K LK. *2004+
1.9.1.9 MKF JERHF, GJ GFLJGDD-JDK JERHF HJHJLGFK.
* 2012+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.9.1.10@F HJKJF KGME NDHJGL LG OGEF F JDK G HJKFL F MLMJ
@DJF HGLFLD, KMKK L@ HGKKD JK G EDGJELGF F
FMJGNDGHEFLD EHJEFLK F F MFGJF @D, HJLMDJDQ OL@ @@
GKK G L@K A! GJ O@F MKF K HJL GHGDQL@JHQ. * 2012+
1.9.2 I>> ;>
1.9.2.1 A! L@JHQ K@GMD GFDQ KLJL GF L@ FGKK G HDHKQ K
GFJE, PHL F PHLGFD JMEKLFK L@L JIMJ KMKKGF F
JEFL LOF L@ HJKJJ, L@ KHDKL F L@ @D, QGMF HJKGF
GJ MDL F L@J EDQ F/GJ JJK K HHJGHJL. *2004+
1.9.2.2 A! L@JHQ K@GMD FLL F MDLK GF L@ JGEEFLGF G
KHDKL. *2004+
1.9.2.3 A! L@JHQ F @DJF F QGMF HGHD K@GMD FLL Q KHDKL.
*2004+
1.9.2.4 @ KGF LG FLL A! L@JHQ K@GMD LF LOF L@ @D, QGMF
HJKGF GJ MDL, L@J EDQ F/GJ JJK (K HHJGHJL) F L@ KHDKL
LJ MDD KMKKGF G L@ JKK F FLK G LJLEFL. @K KMKKGF
K@GMD L FLG GMFL LDK G L@ HJKGF'K HDHKQ KQFJGE, HJGFGKK
F DKLQD. *2004+
1.9.2.5 JLEFL OL@ A! L@JHQ K FJDDQ JGEEF LJ KGF
HDHL KRMJ. *2004+
1.9.2.6 @F HGKKD, @GGK O@@ A! LG GJ GF L@ KK G L@ HJKFLF
HDHKQ KQFJGE. L@ HDHKQ KQFJGE K FGL DJ L HJKFLLGF, K
L@ KGF GF L@ HJKFLF KRMJ LQH(K). * 2012+
1.9.2.7 A! L@JHQ K@GMD GFKJ F KMKK OL@ @DJF, QGMF HGHD
F MDLK F L@J EDQ F/GJ JJK K HHJGHJL LJ JKL
MFHJGNG KRMJ :
L@ @D, QGMF HJKGF GJ MDL @K FMJGDGD L
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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L@ !!# K@GOK MFIMNGD HDHL LNLQ
L@ @D, QGMF HJKGF GJ MDL F/GJ L@J EDQ F/GJ JJK GFKJ L@ JK G
@NF MJL@J KRMJ MFHLD
JF EF K@GOK KLJMLMJD FGJEDLQ. *2004+
1.9.2.8 L K@GMD JGFK L@L KGE @DJF, QGMF HGHD F MDLK (L@JGM@
L@J EDK F/GJ JJK, F KGE FKLFK) EQ @GGK FGL LG L A!
L@JHQ GDDGOF MDD KMKKGF G L@ JKK F FLK. *2004+
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OJ G LJLGF JKK G KGME NDHJGL (K JGEEFLGF 1.9.1.10).
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1.9.3.5 MFLN LJLEFL (K JGEEFLGF 1.9.3.4) K FLN GJ FGL
LGDJL, KMKK OL@, GJ JJ LG, LJLJQ HDHKQ KHDKL. L@J A!K
L@L EQ GFKJ Q L@ LJLJQ HDHKQ KHDKL J KDJRHF
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NLJF F RGFKE14. CJMDDQ GFKJ L@ JKUFL JLG O@F
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1.9.4.5 L@J J KF GJ EQGDGF KRMJK, GJ ! K KMKHL, G FGL GJ
JERHF, HFLF, GPJRHF, H@FQLGF, HJDF, LF
GJ NLJF. * 2012+
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1.9.9.2 CGFKJ KGME NDHJGL GJ LGHJEL14K JKL-DF LJLEFL F @DJF
OL@ JNL KQFJGE. * 2012+
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1.9.11.4 CGFKJ MFLN LJLEFL KGF ODD-LGDJL A! K FLN (K
JGEEFLGFK 1.9.11.2 F 1.9.11.3). * 2012+
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1.9.12.1J KGME NDHJGL K JKL-DF LJLEFL LG @DJF, QGMF HGHD FMDLK OL@ FODQ FGK #!, HJLMDJDQ L@J K H@GLGHJGPQKED
JKHGFK GF !!#. B OJ G LJLGF JKK G KGME NDHJGL (K
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1.9.12.2J DEGLJF14 KGME NDHJGL K MFKMLD GJ FGL LGDJL. B OJ
L@L DEGLJF F PJL EQGDGF KRMJK. ! K KMKHL K
JGEEFLGFK 1.9.13.1 F 1.9.13.2. * 2012+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
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1.9.12.3CGFKJ LGHJEL14 ML OJ L@L L @K DKK NGMJD K-L
HJGD L@F KGME NDHJGL F DEGLJF14. * 2012+
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1.9.12.4J DEGLJF14, DNLJLE14, KGME NDHJGL GJ LGHJEL14 K
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LJLEFLK (K JGEEFLGFK 1.9.12.1, 1.9.12.2 F 1.9.12.3) J
FLN GJ FGL LGDJL. B OJ G LJLGF JKK G KGME NDHJGL
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DGRE14, DGFRHE GJ RGFKE14. * 2012+
1.9.12.6G FGL GJ JERHF, HFLF, GPJRHF, H@FQLGF,
HJDF, LF GJ NLJF. * 2012+
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1.9.13.1J KGME NDHJGL K JKL-DF LJLEFL LG @DJF, QGMF HGHD F
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L@L DEGLJF EQ PJL EQGDGF KRMJK. * 2012+
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@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
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LGDJL. B OJ G LJLGF JKK G KGME NDHJGL (K
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LGDJL, KMKK OL@, GJ JJ LG, LJLJQ HDHKQ KHDKL F GFKJ
DGRE14, DGFRHE GJ RGFKE14. * 2012+
1.9.13.5G FGL GJ JERHF, HFLF, GPJRHF, H@FQLGF,
HJDF, LF GJ NLJF. * 2012+
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K LK, F LGF LG L KRMJK HJKKL. *2004+
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GF L@ JKHGFKDLQ G GFLFMF HJKJF. *2004+
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HJEJQ J DGD JMEKLFK F/GJ DFKF DDGO. *2004+
1.9.17.5@ HJKJJ EMKL FKMJ L@L L@ @D, QGMF HJKGF GJ MDL F L@J
EDQ F/GJ JJK K HHJGHJL J MDDQ FGJE GML LJLEFL FDMF
LGF LG LF LJ EKK GK GJ LJ KLJGFLKLFD MHKL. *2004+
1.9.17.6 A@JF LG LJLEFL F GHLEK OL@ L@ GDDGOF:
MLF @DJF, QGMF HGHD F MDLK F L@J EDK F/GJ JJK F L@
MFJKLFF G L@J GFLGF F L@ JLGFD G LJLEFL
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MDL OL@ HDHKQ F L@J EDQ F/GJ JJK. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.9.17.7MDJ DGG LKL EGFLGJF F MDLK K FGL JGEEF K JGMLF, F
K@GMD GF GFDQ DFDDQ FL. *2004+
1.9.17.8MDJ DGG LKL EGFLGJF F @DJF F QGMF HGHD K FGL
JGEEF K JGMLF, F K@GMD GF GFDQ DFDDQ FL F
JGEEF Q L@ KHDKL. *2004+
1.9.17.9 FLGFK GJ EGFLGJF G A! DGG DNDK J:
LLGF G FGF-@JF LG L@ HJKJ ELGF
KMKHL LGPLQ
MKLEFL G H@FQLGF GK
EFEFL G H@JEGFL FLJLGFK (GJ PEHD, @FK F
GNDDLQ, @FK F DEFLGF, F G-ELGF OL@ FLJLF JMK)
KH DFD GFLGFK, GJ PEHD, KLLMK HDHLMK, GJF DMJ F JLF
KLMLGFK F HJFFQ (K JGEEFLGF 1.15.3.19). *2012+
1.9.17.10!PEHDK G DGG LKLK FDM:
GJ KMJJQ U DGLLF KLMK F L@GK GF KGME NDHJGL16
MDD DGG GMFL, DLJGDQLK, DNJ FRQEK, NLEF DNDK, F GL@J LKLK G
GF ELGDKE (GJ PEHD, KJME DME F DDF H@GKH@LK) NJQ
2U5 QJK GJ MDLK LF FRQE-FMF JMK. *2004+
1.9.17.11AKQEHLGEL EFGJ FGJEDLK F LKL JKMDLK J FGL FKKJDQ F
FLGF GJ @FK F ELGF. *2004+
1.9.18 >
1.9.18.1@ KGF LG GFLFM GJ OL@JO ELGF K@GMD LF Q L@ @D,
QGMF HJKGF GJ MDL, L@J EDQ F/GJ JJK K HHJGHJL, F L@
KHDKL LJ MDD KMKKGF G L@ JKK F FLK G OL@JOD. AL L@
F G L@ KMKKGF @DJF, QGMF HGHD F MDLK, F L@J EDQ F/
GJ JJK K HHJGHJL, K@GMD MFJKLF L@J JK G KRMJ JMJJF GF
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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F G LJLEFL. @K KMKKGF K@GMD L FLG GMFL LDK G L@ @D,
QGMF HJKGF GJ MDL'K HDHKQ KQFJGE, HJGFGKK F DKLQD. *2004+
1.9.18.2L@JOD G A!K EMKL EF Q, GJ MFJ L@ MF G, L@
KHDKL. *2004+
1.9.18.3@ JKK F FLK G GFLFMF GJ OL@JOF A! L@JHQ K@GMD
KMKK OL@ @DJF, QGMF HGHD F MDLK, F L@J EDK F/GJ
JJK K HHJGHJL, O@G @N F KRMJ J GJ L DKL 2 QJK (K
HHFP $17 G L@ MDD MDF). *2004+
1.9.18.4@F A! LJLEFL K F KGFLFM F @D, QGMF HJKGF GJ MDLO@G @K F KRMJ J, L K@GMD JJ GML KDGODQ (L DKL
2U3 EGFL@K) F GF JM K@GMD OL@JOF L LE. *2004+
1.9.18.5JLMDJ J K@GMD LF O@F OL@JOF FRGRHFK F
JLMJLK (EQ L MH LG 6 EGFL@K GJ DGFJ) MK G L@ HGKKDLQ G
JM-JDL OL@JOD KQEHLGEK F/GJ KRMJ JMJJF. *2004+
1.9.18.6@J K@GMD DK HDF J OL@ @DJF, QGMF HGHD F MDLKF L@J EDK F/GJ JJK K HHJGHJL, O@JQ KRMJK JMJ, L@
DKL GK JMLGF K JNJK F ED N K KGM@L. *2004+
1.10 Referral for complex or refractory epilepsy
1.10.1 ADD @DJF, QGMF HGHD F MDLK OL@ HDHKQ K@GMD @N KK N
L@J KHDKL LG LJLJQ KJN O@F JMEKLFK JIMJ. *2004+
1.10.2 KRMJK J FGL GFLJGDD F/GJ L@J K FGKL MFJLFLQ GJ LJLEFL
DMJ, @DJF, QGMF HGHD F MDLK K@GMD JJJ LG LJLJQ
KJNK KGGF9 GJ MJL@J KKKKEFL. JJD K@GMD GFKJ O@F
GF GJ EGJ G L@ GDDGOF JLJ J HJKFL:
L@ HDHKQ K FGL GFLJGDD OL@ ELGF OL@F 2 QJK
EFEFL K MFKMKKMD LJ LOG JMK
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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L@ @D K MFJ 2 QJK
@D, QGMF HJKGF GJ MDL PHJFK, GJ K L JK G, MFHLD K LK
JGE ELGF
L@J K MFDLJD KLJMLMJD DKGF
L@J K HKQ@GDGD F/GJ HKQ@LJ G-EGJLQ
L@J K FGKL GML K LG L@ FLMJ G L@ KRMJK F/GJ KRMJ KQFJGE.
*2004+
1.10.3 F @DJF, L@ FGKK F EFEFL G HDHKQ OL@F L@ JKL O
QJK G D EQ PLJEDQ @DDFF. GJ L@K JKGF, @DJF OL@
KMKHL HDHKQ K@GMD JJJ LG LJLJQ KJNK JDQ, MK G L@
HJGGMF NDGHEFLD, @NGMJD F HKQ@GDGD LK L@L EQ
KKGL OL@ GFLFMF KRMJK. *2004+
1.10.4 B@NGMJD GJ NDGHEFLD JJKKGF GJ FDLQ LG FLQ L@ HDHKQ
KQFJGE F @D, QGMF HJKGF GJ MDL K@GMD JKMDL F EEL JJJD
LG LJLJQ KJNK. *2004+
1.10.5 C@DJF, QGMF HGHD F MDLK OL@ KH KQFJGEK KM@ K
LMJUJ KQFJGE, L@ @EKH@J KQFJGEK, KEMKKF'K
FH@DLK F @QHGL@DE @EJLGE K@GMD JJJ LG LJLJQ
HDHKQ KJN. *2004+
1.10.6 KQ@LJ G-EGJLQ F/GJ FLN KDF FNKLLGFK K@GMD FGL
GFLJFLGF GJ JJJD LG LJLJQ KJN18. *2004+
1.10.7 @ LJLJQ KJN K@GMD FDM EMDLKHDFJQ LE, PHJF F L@
KKKKEFL G @DJF, QGMF HGHD F MDLK OL@ GEHDP HDHKQ, F
@N IML KK LG FNKLLGFK F LJLEFL Q GL@ ED F
KMJD EFK. *2004+
1.10.8 @ PHJLK G EMDLKHDFJQ LEK FNGDN F EFF GEHDP
HDHKQ K@GMD FDM HKQ@GDGQ, HKQ@LJQ, KGD OGJ, GMHLGFD
L@JHQ, GMFKDDF, FMJGJGDGQ, DFD FMJK KHDKLK,
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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FMJGH@QKGDGQ, FMJGDGQ, FMJGKMJJQ F FMJGFKL@K. EK
K@GMD @N F NG LDELJQ DLK NDD LG L@E. *2004+
1.10.9 @ FMJGKMJGF F L@ EMDLKHDFJQ LE K@GMD @N KHDKL
PHJF G F/GJ LJFF F HDHKQ KMJJQ F @N KK LG FNKN
!!# JGJF DLK. *2004+
1.10.10 FGJELGF K@GMD HJGN LG @DJF, QGMF HGHD F MDLK F
EDK F/GJ JJK K HHJGHJL GML L@ JKGFK GJ GFKJF
KMJJQ. @ FLK F JKK G L@ KMJD HJGMJ MFJ GFKJLGF
K@GMD MDDQ PHDF GJ FGJE GFKFL K GLF. *2004+
1.11 Psychological interventions
1.11.1 KQ@GDGD FLJNFLGFK (JDPLGF, GFLN @NGMJ L@JHQ,
G) EQ MK F GFMFLGF OL@ A! L@JHQ F MDLK O@J
L@J L@ HJKGF GJ L@ KHDKL GFKJK KRMJ GFLJGD LG FIML
OL@ GHLED A! L@JHQ. @K HHJG@ EQ KKGL OL@ F EHJGN
IMDLQ G D F KGE HGHD. *2004+
1.11.2 KQ@GDGD FLJNFLGFK (JDPLGF, GFLN @NGMJ L@JHQ) EQ
MK F @DJF F QGMF HGHD OL@ JM-JKKLFL GD HDHKQ. *2004+
1.11.3 KQ@GDGD FLJNFLGFK EQ MK K MFLN L@JHQ. @Q @N FGL
F HJGNF LG L KRMJ JIMFQ F J FGL F DLJFLN LG
H@JEGDGD LJLEFL. *2004+
1.12 Ketogenic diet
1.12.1 J @DJF F QGMF HGHD OL@ HDHKQ O@GK KRMJK @N FGL
JKHGF LG HHJGHJL A!K LG LJLJQ HLJ HDHKQ KHDKL GJ
GFKJLGF G L@ MK G LGF L. * 2012+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.13 Vagus nerve stimulation (VNS)
1.13.1 MK FJN KLEMDLGF K FL GJ MK K F MFLN L@JHQ F
JMF L@ JIMFQ G KRMJK F MDLK O@G J JJLGJQ LG FLHDHL
ELGF ML O@G J FGL KMLD GJ JKLN KMJJQ. @K FDMK MDLK
O@GK HDHL KGJJ K GEFL Q GD KRMJK19 (OL@ GJ OL@GML
KGFJQ FJDKLGF) GJFJDK KRMJK. *2004, 2012+
1.13.2 MK FJN KLEMDLGF K FL GJ MK K F MFLN L@JHQ F
JMF L@ JIMFQ G KRMJK F @DJF F QGMF HGHD O@G J
JJLGJQ LG FLHDHL ELGF ML O@G J FGL KMLD GJ JKLN
KMJJQ. @K FDMK @DJF F QGMF HGHD O@GK HDHL KGJJ K
GEFL Q GD KRMJK19 (OL@ GJ OL@GML KGFJQ FJDKLGF) GJ
FJDK KRMJK20. *2004, 2012+
1.14 Prolonged or repeated seizures and convulsive status
epilepticus
1.14.1 F- >> < = >
; < )
=? ?>
1.14.1.1#N EEL EJFQ J F LJLEFL LG @DJF, QGMF HGHD F
MDLK O@G @N HJGDGF (DKLF 5 EFMLK GJ EGJ) GJ JHL (L@J GJ
EGJ F F @GMJ) GFNMDKN KRMJK F L@ GEEMFLQ. *2012+
1.14.1.2FDQ HJKJ MD ERGDE GJ JLD RHE21 GJ MK F L@
GEEMFLQ GJ @DJF, QGMF HGHD F MDLK O@G @N @ HJNGMKHKG G HJGDGF GJ KJD GFNMDKN KRMJK. * 2012+
1.14.1.3AEFKLJ MD ERGDE K JKL-DF LJLEFL F @DJF, QGMF HGHD
F MDLK OL@ HJGDGF GJ JHL KRMJK F L@ GEEMFLQ. AEFKLJ
JLD RHE21 HJJJ GJ MD ERGDE K FGL NDD.
FLJNFGMK KK K DJQ KLDK@ F JKMKLLGF DLK J
NDD, EFKLJ FLJNFGMK DGJRHE. * 2012+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.14.1.4JLEFL K@GMD EFKLJ Q LJF DFD HJKGFFD GJ, KH
Q F FNMDDQ J HJGLGGD JOF MH OL@ L@ KHDKL, Q EDQ
EEJK GJ JJK OL@ HHJGHJL LJFF. *2004+
1.14.1.5CJ EMKL LF LG KMJ L@ @D, QGMF HJKGF GJ MDL'K JOQ F
KKKK @K GJ @J JKHJLGJQ F J MFLGF. *2004+
1.14.1.6HFF GF JKHGFK LG LJLEFL, L@ HJKGF'K KLMLGF F FQ
HJKGFDK J HDF, DD F EMDF, HJLMDJDQ :
L@ KRMJ K GFLFMF 5 EFMLK LJ L@ EJFQ ELGF @K F
EFKLJ
L@ HJKGF @K @KLGJQ G JIMFL HKGK G KJD KRMJK GJ @K GFNMDKN
KLLMK HDHLMK, GJ L@K K L@ JKL HKG JIMJF EJFQ LJLEFL
-
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1.14.2.2AEFKLJ FLJNFGMK DGJRHE K JKL-DF LJLEFL F @GKHLD F @DJF,
QGMF HGHD F MDLK OL@ GFGF FJDK LGFUDGF KRMJK
(GFNMDKN KLLMK HDHLMK). AEFKLJ FLJNFGMK RHE FLJNFGMK
DGJRHE K MFNDD, GJ MD ERGDE MFD LG KMJ EEL
FLJNFGMK KK. AEFKLJ EPEME G LOG GKK G L@ JKL-DF
LJLEFL (FDMF HJ-@GKHLD LJLEFL). DKG L@ KMKL HJGLGGDK
F HHFP . * 2012+
1.14.2.3 KRMJK GFLFM, EFKLJ FLJNFGMK H@FGJLD GJ H@FQLGF K
KGF-DF LJLEFL F @GKHLD F @DJF, QGMF HGHD F MDLK OL@
GFGF FJDK LGFUDGF KRMJK (GFNMDKN KLLMK HDHLMK).
DKG L@ KMKL HJGLGGDK F HHFP . * 2012+
#>?= ;;>?=
1.14.2.4GDDGO L@ KMKL HJGLGGDK F HHFP GJ LJLF JJLGJQ GFNMDKN
KLLMK HDHLMK F KGFJQ J. *2012+
1.14.2.5AEFKLJ FLJNFGMK ERGDE21, HJGHGGD21 GJ L@GHFLD KGME21 LG LJL
MDLK OL@ JJLGJQ GFNMDKN KLLMK HDHLMK. AIML EGFLGJF,
FDMF DGG DNDK G A!K, F JLD D KQKLEK KMHHGJL J JIMJ.
DKG L@ KMKL HJGLGGDK F HHFP . * 2012+
1.14.2.6AEFKLJ FLJNFGMK ERGDE21 GJ L@GHFLD KGME21 LG LJL @DJF
F QGMF HGHD OL@ JJLGJQ GFNMDKN KLLMK HDHLMK. AIML
EGFLGJF, FDMF DGG DNDK G A!K, F JLD D KQKLEK KMHHGJL J
JIMJ. DKG L@ KMKL HJGLGGDK F HHFP . *2012+
1.14.2.7AK L@ LJLEFL HL@OQ HJGJKKK, L@ PHJLK G F FKL@LKL/
FLFKNKL K@GMD KGM@L. *2004+
1.14.2.8 L@J L@ O@GD HJGLGGD GJ FLFKN J K JIMJ L@ LJLJQ KJN
K@GMD GFKMDL. *2004+
1.14.2.9MDJ A!K K@GMD GFLFM L GHLED GKK F L@ JKGFK GJ KLLMK
HDHLMK K@GMD FNKLL. *2004+
@ HDHKK: L@ FGKK F EFEFL G L@ HDHKK F
MDLK F @DJF F HJEJQ F KGFJQ J*C! DFD
MDF 137
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1.14.2.10AF FNMD LJLEFL HL@OQ K@GMD GJEMDL GJ @DJF, QGMF
HGHD F MDLK O@G @N JMJJFL GFNMDKN KLLMK HDHLMK. *2004+
1.14.3 -@?=@ =>>?= ;;>?=
1.14.3.1*GF-GFNMDKN KLLMK HDHLMK K MFGEEGF F EFEFL K DKK
MJFL. A KMKL MDF F GMF F HHFP . *2004+
1.15 Women and girls with epilepsy
1.15.1 I @ < ;;=
1.15.1.1 F GJJ LG FD FGJE KGFK F @G, F LG JM
EKMFJKLFFK, OGEF F JDK OL@ HDHKQ F L@J HJLFJK, K
HHJGHJL, EMKL NF MJL FGJELGF F GMFKDDF GML
GFLJHLGF, GFHLGF, HJFFQ, JF GJ @DJF F JKLF,
F EFGHMK. *2004+
1.15.1.2 FGJELGF GML GFLJHLGF, GFHLGF, HJFFQ, GJ EFGHMK K@GMD
NF LG OGEF F JDK F NF G KPMD LNLQ, HJFFQ GJ
EFGHMK, F L@ FGJELGF K@GMD LDGJ LG L@J FNMD FK.
@K FGJELGF K@GMD DKG NF, K F, LG HGHD O@G J DGKDQ
FNGDN OL@ OGEF F JDK OL@ HDHKQ. @K EQ FDM @J EDQ F/
GJ JJK. *2004+
1.15.1.3ADD @DL@J HJGKKGFDK O@G LJL, J GJ, GJ KMHHGJL OGEF F JDK
OL@ HDHKQ K@GMD EDJ OL@ JDNFL FGJELGF F L@ NDDLQ G
GMFKDDF. *2004+
1.15.1.4KMKK OL@ OGEF F JDK G @DJF HGLFLD (FDMF QGMF JDK
O@G J DDQ LG F LJLEFL FLG L@J @DJF QJK), F L@J
HJFLK F/GJ JJK HHJGHJL, L@ JK G A!K MKF EDGJELGFK
F HGKKD FMJGNDGHEFLD EHJEFLK F F MFGJF @D. AKKKK L@
JKK F FLK G LJLEFL OL@ FNMD JMK. @J J DEL L GF
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JK G GFLFM MK G KGME NDHJGL LG L@ MFGJF @D, F OJ L@L
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1.16 Children, young people and adults with learningdisabilities (see also sections